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Medicare for All Is Better Than Union Health Care

A new report shows that union health plans, while better than employer-sponsored health care, pale in comparison to Medicare for All. The labor movement should take notice: union members would be better off with M4A than the health plans they have to fight so hard to protect.

Sen. Bernie Sanders introduces health care legislation titled the "Medicare for All Act of 2019" during a news conference on Capitol Hill, on April 9, 2019 in Washington, DC. (Mark Wilson / Getty Images)

The 1947 Taft-Hartley Act banned radicals from union leadership positions, prohibited solidarity and wildcat strikes, and cleared obstacles to union-busting right-to-work laws. For these reasons, it’s rightly remembered for contributing to the atrophy of the labor movement. But Taft-Hartley also did something else that is less well-understood, and due for an honest appraisal. It created a whole new type of health care agreement: the multiemployer union health plan.

Today, nearly six million Americans are on such health plans. They work differently from employer-sponsored health plans and are generally superior. Through collective bargaining agreements, multiple employers agree to pay into a trust fund, which is then managed jointly by representatives from both the union and the companies. This usually results in better coverage for workers than plans that are unilaterally decided by penny-pinching bosses.

To hear Democratic Party politicians tell it, union health plans are the cream of the crop. So great is the Democratic establishment’s regard for them that you’d almost get the impression that this one provision alone made up for everything else in the anti-union Taft-Hartley Act.

Of course, top Democrats don’t gush about union health plans all the time: it usually occurs in the context of debates about single-payer health care. This last presidential primary, the notion that union health plans are superior to any other type of health plan — not only in existence, but in imagination, too — was consistently trotted out as an argument against Medicare for All.

Joe Biden, Amy Klobuchar, and Pete Buttigieg all recited some version of the talking point that Medicare for All would undo all the hard work labor unions had put into securing the very best health coverage for their members, and was therefore an anti-union policy. Likewise, Elizabeth Warren rushed to the defense of the leadership of the Culinary Workers Union in Las Vegas when it was roundly criticized for repeating that same talking point in communications with its members.

It’s a clever political maneuver, devised to make a pro-corporate objection to single-payer health care appear pro-worker instead. But is it true? Are union health plans the best any ordinary working person can hope for?

A labor movement fulfilling its mandate to improve the working and living conditions of union members and the broader working class would show interest in this question, since the answer determines whether or not it should tolerate being used as a political cudgel against Medicare for All. To its credit, that spirit of inquiry seems to have stirred in the International Union of Painters and Allied Trades (IUPAT), which commissioned a report on the subject from Matt Bruenig’s People’s Policy Project.

The completed report, which is published today, is titled “How Medicare for All & Bidencare Would Affect Union Health Plans.” The union supplied the report’s authors, Matt Bruenig and Jon Walker, with detailed data that allowed them to create profiles of three hypothetical IUPAT members, each representative of a typical worker over a range of salaries and locals.

They named these hypothetical union members Dave, Luis, and Sam. The authors then set about determining how Dave, Luis, and Sam’s health spending would be affected by Medicare for All and Joe Biden’s proposed health plan, respectively. They found that Medicare for All and so-called Bidencare would both be less expensive for all three workers than their union health plans, mounting a strong challenge to the consensus that union health plans are as good as it gets.

Crucially, Bruenig and Walker found that Medicare for All would have a much bigger impact on Dave, Luis, and Sam’s savings than Biden’s plan. “We find that Bidencare could save these IUPAT members $676 to $3,253 per year while Medicare for All would save them $4,868 to $7,866 per year.” Overall, explain Bruenig and Walker, “the findings are that the existing union plans are the most expensive, [Bidencare] is somewhat less expensive, and the Medicare for All plan is much less expensive.”

An opponent of single-payer might object that savings aren’t the whole story. But Bruenig and Walker’s analysis is based on Bernie Sanders’s specific vision for Medicare for All, which everything that requires a doctor is covered, including things that aren’t currently covered in many plans, like vision, dental, and mental health care. Bruenig and Walker factored in the 7.5 percent employer-side payroll tax and the 4 percent individual income tax required to pay for comprehensive, continuous coverage for everyone, and still found Medicare for All to be less expensive for workers than the alternatives. (The importance of coverage continuity has never been clearer than during the coronavirus pandemic, the report’s authors note, as mass unemployment causes unions’ health trust funds to dry up — a major vulnerability of the structure established by Taft-Hartley.)

Again, it’s true that union health care plans are frequently better than employer-sponsored health care plans. But they’re not better for workers than Medicare for All. They’re not even better for workers than the compromise plan Joe Biden’s campaign was compelled to cobble together in response to the popularity of Medicare for All during the presidential primary.

The report concludes with a recommendation to the union that commissioned it, as well as the rest of the labor movement. “We believe that unions like IUPAT should take a stance in favor of Medicare for All for the benefit of their own members and the working class generally,” write Bruenig and Walker.

In other words, if the labor movement really exists to serve Dave, Luis, and Sam, as well as their family and friends who aren’t fortunate enough to have union representation, it will stop letting the notion of supposedly supreme union health plans to be used as a weapon against Medicare for All.